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Clinical Pharmacokinetics
Published in: Clinical Pharmacokinetics 6/2018

Open Access 01-06-2018 | Review Article

Clinical Pharmacokinetic and Pharmacodynamic Profile of Riociguat

Authors: Reiner Frey, Corina Becker, Soundos Saleh, Sigrun Unger, Dorina van der Mey, Wolfgang Mück

Published in: Clinical Pharmacokinetics | Issue 6/2018

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Abstract

Oral riociguat is a soluble guanylate cyclase (sGC) stimulator that targets the nitric oxide (NO)–sGC–cyclic guanosine monophosphate pathway with a dual mode of action: directly by stimulating sGC, and indirectly by increasing the sensitivity of sGC to NO. It is rapidly absorbed, displays almost complete bioavailability (94.3%), and can be taken with or without food and as crushed or whole tablets. Riociguat exposure shows pronounced interindividual (60%) and low intraindividual (30%) variability in patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), and is therefore administered using an individual dose-adjustment scheme at treatment initiation. The half-life of riociguat is approximately 12 h in patients and approximately 7 h in healthy individuals. Riociguat and its metabolites are excreted via both renal (33–45%) and biliary routes (48–59%), and dose adjustment should be performed with particular care in patients with moderate hepatic impairment or mild to severe renal impairment (no data exist for patients with severe hepatic impairment). The pharmacodynamic effects of riociguat reflect the action of a vasodilatory agent, and the hemodynamic response to riociguat correlated with riociguat exposure in patients with PAH or CTEPH in phase III population pharmacokinetic/pharmacodynamic analyses. Riociguat has a low risk of clinically relevant drug interactions due to its clearance by multiple cytochrome P450 (CYP) enzymes and its lack of effect on major CYP isoforms and transporter proteins at therapeutic levels. Riociguat has been approved for the treatment of PAH and CTEPH that is inoperable or persistent/recurrent after surgical treatment.
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Metadata
Title
Clinical Pharmacokinetic and Pharmacodynamic Profile of Riociguat
Authors
Reiner Frey
Corina Becker
Soundos Saleh
Sigrun Unger
Dorina van der Mey
Wolfgang Mück
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Clinical Pharmacokinetics / Issue 6/2018
Print ISSN: 0312-5963
Electronic ISSN: 1179-1926
DOI
https://doi.org/10.1007/s40262-017-0604-7

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